Physical Activity Readiness Questionnaire (PAR-Q)

1
Full Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Phone Number (Optional)
Area Code
Phone Number
4
How did you find me?* This field is required.
Please Select
Please Select
Word of mouth
Instagram
LinkeIn
Web Search
Facebook
Business Card
Advert
Other
5
What are your primary fitness and wellbeing goals? Please expand on this* This field is required.
6
What is currently stopping you from reaching your goals? Please expand on this* This field is required.
7
How many hours can you dedicate to exercise each week?* This field is required.
0 - 1
3 - 6
7 - 10+
8
On a scale of 1-10, how serious are you about improving your fitness and wellbeing? 1 = not bothered, 10 = fully committed* This field is required.
9
Are you willing to invest £100-£500 per month in your health and fitness?* This field is required.
YesNo
10
Thank you for taking the time to complete this coaching application. Once you have clicked 'submit', I will endeavour to respond within 2 working days.

Best, Jackson

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